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This study explores service providers’ accounts of working with sexual and gender minority (SGM) youth and the improvised and non-institutionalized adaptations to their delivery of care in response to the COVID-19 pandemic. We present a narrative analysis of data from qualitative, in-depth semi-structured interviews conducted between July 2020 and August 2021 with 16 service providers who deliver programs and services for SGM youth in British Columbia (BC), Canada. Drawing on a central narrative of uncertainty in driving improvised adaptations to service provision amid the pandemic, we identified three sub-narratives: (i) uncertainty as characteristic of liminality; (ii) uncertainty as conducive to cooperation and collaboration; and (iii) uncertainty as enabling ‘blue-sky thinking’ and innovation. In each sub-narrative, we document service providers’ accounts of how they navigated both uncertainty in the absence of direction from their organizations and constraint by COVID-19 public health mandates and guidelines. Amid pandemic-driven interruptions in structured guidance, these improvised practices of care became key in shaping the delivery of care to SGM youth in BC. These accounts offer insights into how uncertainty can be harnessed as a potent source of improvement of services for SGM youth now and throughout future phases of the COVID-19 pandemic.